Burgh Road Industrial Estate, Carlisle, Cumbria, CA2 7NA Telephone: (01228) 404550 Facsimile: (01228) 404551 APPLICATION FOR EMPLOYMENT (PLEASE COMPLETE IN BLOCK CAPITALS) Vacancy or type of work applied for.. PART 1 PERSONAL DETAILS Title... Surname. First names(s)..... Current address..... Tel no STD home. Postcode..... Mobile no...... Work no May we contact you at work Yes No Are you legally eligible for employment in the UK?.... In the event of you being offered employment, you will be required to provide evidence of your eligibility to work legally in the United Kingdom in compliance with Section 8 of the Immigration Asylum Act 1996. National Insurance no... Do you have any holiday commitments you may wish us to honour?. Have you previously been employed by us? Please provide details (i.e. job title and dates employed)....... Please summarise briefly why you would like to work for us: Story Homes Limited Registered No. 2275441 Registered Office: Burgh Road Industrial Estate, Carlisle, Cumbria CA2 7NA e-mail: recruitment@storyhr.co.uk web site: www.storyhomes.co.uk SMOKING the company operates a no smoking policy STY/FRM/233 Rev No. E Page 1 of 7 Effective Date: 03/06/13
PART 2 SUMMARY OF EMPLOYMENT HISTORY Please list all paid and unpaid employment, including any gaps in employment, starting with the most recent employer first. Name and address of organisation....... Date started... Date left. Reason for leaving/wanting to leave.... Job title Salary/rate of pay........ Car/van Any other benefits e.g. overtime, bonus... Notice required........ Outline of key responsibilities/duties....... Name and address of organisation...... Date started... Date left. Reason for leaving/wanting to leave.... Job title Salary/rate of pay.... Car/van Any other benefits e.g. overtime, bonus... Notice required.... Outline of key responsibilities/duties....... Name and address of organisation...... Date started... Date left. Reason for leaving/wanting to leave.... Job title Salary/rate of pay.... Car/van Any other benefits e.g. overtime, bonus... Notice required.... Outline of key responsibilities/duties....... STY/FRM/233 Rev No. E Page 2 of 7 Effective Date: 03/06/13
Other Employers Name & address From To Job title Salary/wage PART 3 TRAINING / QUALIFICATIONS & SKILLS Training / qualification Grade (if applicable) Date obtained Secondary Schools/Colleges attended (Up to age 18) School/college Dates Qualifications obtained (with grades) Further/Higher Education School/college/university Dates Full and part-time Qualifications obtained (Class/division) Professional qualifications please give dates and membership grades STY/FRM/233 Rev No. E Page 3 of 7 Effective Date: 03/06/13
Short courses attended and in-company training (i.e. Management Trainee, Apprentice, etc.) Subject/activity Year Duration Organising body Do you hold any of the following certificates? CSCS (please state categories below) CSCS card Number... First Aid Manual Handling Road & Streetworks Mobile Tower Scaffold Slinger/Signaller Please tick appropriate boxes: CPCS (please state categories below) CPCS card Number... Chainsaw Operator Confined Spaces IPAF Abrasive Wheels CITB 5 Day Site Safety Industry Passport Schemes Others (please provide details).. PREVIOUS EXPERIENCE MS Word: Often: Rarely: Never: MS Access: Often: Rarely: Never: MS Outlook: Often: Rarely: Never: MS Excel: Often: Rarely: Never: PowerPoint: Often: Rarely: Never: Accounting Software: Often: Rarely: Never: Teamworking Often: Rarely: Never: Meeting Deadlines: Often: Rarely: Never: Meeting Clients: Often: Rarely: Never: STY/FRM/233 Rev No. E Page 4 of 7 Effective Date: 03/06/13
Please supply as much information as possible on other relevant experience (use additional sheets if required, writing your name at the top of each sheet). PART 4 - AVAILABILITY FOR EMPLOYMENT When could you be available to commence work for Story Homes Are you prepared to travel? (site specific) Do you hold a current driving licence? Do you own a car? Date. 1. Have you ever been disqualified for or convicted of drink driving? 2. Have you ever been disqualified or convicted of any other driving offence? If you have answered yes to either of the above 2 questions, please give details and dates................... NB: Site employees may be required to perform driving duties as part of their employment. This does not apply to apprentices. Have you ever been convicted of a criminal offence, other than a spent conviction under the Rehabilitation of Offenders Act 1974? If yes, please give details and dates:.... Type of work/hours preferred Please complete this section if your application is speculative or the job advertised is part-time, includes weekends etc. Full-time: Part-time: days available to work (mornings or afternoons or whole days)........ STY/FRM/233 Rev No. E Page 5 of 7 Effective Date: 03/06/13
PART 5 GENERAL REFEREES Any offer of employment is subject to the receipt of satisfactory references. Both Referees should have line management knowledge/experience of your work skills. One Referee must be your current or last employer. Neither should be a relative. Name.. Company..... Address..... Position.. Tel no.. Name.. Company..... Address..... Position.. Tel no.. We will not contact your current employer without your consent. I understand that Story Homes, and any other relevant person may use the information contained in this form for the purpose of monitoring equal opportunity, non discrimination and the effectiveness of its recruitment procedures and I consent to its use. I declare that the information I have given is true and accurate to the best of my knowledge and belief. I understand that knowingly providing false information on this form or providing misleading information may bar me from employment or render me liable to disciplinary proceedings, which may include dismissal. Signed.. Date.. OFFICE USE Position offered Date of commencement... Regret letter sent (date) Managers signature... Reference no. Date applied for Date received Satisfactory 1 2 Please note: If you are unsuccessful on this occasion, your application form will be kept on file for 24 months. It will then be destroyed to comply with the Data Protection Act. The Company is registered under the Data Protection Act 1998. STY/FRM/233 Rev No. E Page 6 of 7 Effective Date: 03/06/13